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Monthly Archives: June 2015

A hammertoe is a toe that is contracted at the PIP joint (middle joint in the toe), potentially leading to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. Hammer toes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing against the shoe.

Causes

Hammertoes are a contracture of the toes as a result of a muscle imbalance between the tendons on the top of the toes (extensor tendons) and the tendons on the bottom of the toes (flexor tendons). If there is an imbalance in the foot muscles that stabilize the toe, the smaller muscles can be overpowered by the larger flexor and extensor muscles.

Symptoms

Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most common at the level of the affected joint due to continuous friction of the deformity against your shoes.

Diagnosis

The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment

Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot, check for fractures and determine the cause. The podiatrist may see you to take care of any corns that develop due to the bone deformities. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure. Padding techniques may be used to straighten the toe if the deformity is flexible, or pads may Hammer toe be used to lessen the pressure on the area of the corn or ulcer. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgical Treatment

Surgery to correct for a hammertoe may be performed as a day procedure. There are several different types of procedures that can be used depending on the foot structure and if the deformity is flexible or rigid.

Prevention

Prevention of a hammertoe can be difficult as symptoms do not arise until the problem exists. Wearing shoes that have extra room in the toes may eliminate the problem or slow down the deformity from getting worse. Sometimes surgery is recommended for the condition. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.

Overpronation is the most common abnormality found in the foot, and for this reason, is the most studied. The term that most people attribute to overpronation is ?flat feet.? Pronation is the rolling in of the foot and the collapse of the arch. Every person pronates to some extent and this is a necessary moment in the normal walking cycle as it allows the forefoot to make complete contact with the ground. A foot that overpronates acts like a loose bag of bones during the walking cycle. This makes this type of foot very flexible but inefficient. The foot has to work much harder to propel the body, fatiguing easily and placing mechanical stresses on the lower body. We like to use the analogy of digging a hole in the dirt. Overpronating feet are like using a broom to dig the hole. It won?t break down quickly, but you will be digging for a very long time, or until eventually wear and tear will take effect. Wouldn?t you rather have a shovel to work with. This is in essence what an orthotic can do for your feet. This is why orthotics have become an evidence based treatment for so many foot ailments, as they can effectively manage overpronation.Overpronation is when a person pronates too much and for too long. This places excess stress on the tendons and ligaments in the foot and ankle.

Causes

A common cause of pronation is heredity – we can inherit this biomechanical defect. The second most common cause is due to the way our feet were positioned in the uterus while we were developing; this is called a congenital defect. In either instance, the following occurs in our feet during our development.

Symptoms

Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.

Non Surgical Treatment

Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.

Surgical Treatment

Depending on the severity of your condition, your surgeon may recommend one or more treatment options. Ultimately, however, it’s YOUR decision as to which makes the most sense to you. There are many resources available online and elsewhere for you to research the various options and make an informed decision.